Cotrimoxazole

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Cotrimoxazole

Co-trimoxazole is a combination of sulfamethoxazole,


a sulfa drug and Trimethoprim in a ratio 5: 1
Preparation available:
Tablet, suspension
Tablet ( sulfamethoxazole 400mg + Trimethoprim 80mg)=480
Tablet (sulfamethoxazole 800mg + Trimethoprim 160mg )=960

Suspension:
(40mg+ 200 mg ) per 5 ml
MOA
Folate antagonist
 They inhibit the folic acid synthesis in bacteria.

 Folic acid is required for synthesis of DNA, RNA,


Protein, Aminoacid.

 Human can absorb folic acid from diet but bacteria


can’t.
 Bacteria synthesize folic acid from PABA
MOA
 p-aminobenzoic acid (PABA)

 sequentially interfere with folic acid synthesis by bacteria.

 Sulfamethoxazole, a structural analogues, competitively


block PABA incorporation into folic acid

 Trimethoprim competitively inhibits dihydrofolate


reductase and prevent the reduction of dihydrofolic acid to
tetrahydrofolic acid
Cotrimoxazole MOA
What are the benefit of combination?
 There is synergistic action.

 When used individually they are bacteriostatic but


in combination they are bactericidal

 They decrease the emergence of resistance

 Individual drug has narrow spectrum but in


combination they are broad spectrum
Therapeutic uses
 UTI
 Chronic Bronchitis
 Pneumonia
 Gonorrhoea
 ENT infections
 Genital infections
 RTI
A/E
Nausea, vomiting, Rashes
Megaloblastic anemia
Thrombocytopenia
Leucopenia
Aplastic anemia
Granulocytopenia
Photosensitivity
Hypersensitivity reactions
Stevens- johnson syndrome
C/I
• Hematological disorder
• Pregnancy
• Lactation
• Renal & hepatic disorder
• Hypersensitivity to sulfonamides
Dose
 Tablet ( sulfamethoxazole 400mg +
Trimethoprim 80mg)=480
 Tablet (sulfamethoxazole 800mg +
Trimethoprim 160mg )=960

BD for 5-14 days

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